Urinary Incontinence Surgery -- Sling Procedures

Definition

Urethral suspension is a surgery to reduce or correct stress incontinence in women. The process uses a sling device to support the urethra, the tube that carries urine from the bladder to the outside of the body.

Reasons for Procedure

Stress
incontinence
is uncontrolled leaking of urine. Muscles in the pelvis support the bladder and urethra. When these muscles are weakend these structures can fall. This makes it difficult for the urethra to close to prevent urine leakage from the bladder when there is pressure on bladder, like coughing.

This type of stress incontinence surgery inserts a sling to support the urethra. Lifting the urethra makes it easier for the urethra to close when it should to stop urine leakage from the bladder.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a urethral suspension, your doctor will review a list of possible complications which may include:

Bleeding

Infection

Reactions to anesthesia

Inability to urinate

Continued incontinence or recurrence of the problem

Damage to other nearby organs or blood vessels

Erosion or loosening of the mesh material used during the procedure

Pain, such as during sexual intercourse

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

What to Expect

Prior to Procedure

A series of tests will be done to determine the cause of incontinence. Surgery is only considered after other nonsurgical treatments have been tried. The results from the tests may also be used to prepare for surgery.

Leading up to surgery:

Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.

Arrange for a ride home from the hospital.

Do not eat or drink anything after midnight the night before.

Anesthesia

The choice of anesthesia will depend on the doctor, your sepcific procedure, your medical history, and your preferences. You may receive one of the following:

Local anesthesia—medication will numb the specifc areas that are affected. A sedation medication may also be given to help you relax.

Description of Procedure

There are a variety of sling surgeries. Surgeries can vary by the direction or attachment of the sling. The following is a general description of procedure.

Two small incisions will be made in the lower abdomen or upper thighs. A speculum will be inserted into the vagina to access the inner walls. An incision will be made in the front wall of the vagina. A tunnel or path will be made from the vaginal wall to the area below the abdominal/thigh incisions. A synthetic mesh tape or sling device will be inserted through the incision in the vagina. Each end of the sling has a needle. One needle will be placed through the tunnel that was created and passed through to the abdominal/thigh incision. The steps will be repeated for the other side of the sling. This will place the sling just below behind the urethra. Some tests may be done to make sure the urethra is properly supported. This may include a cough test or a scope passed through the urethra. The tape will be adjusted if needed. Once the position is confirmed, the ends of the sling will be trimmed so that they sit just inside the incisions. All the incisions will then be closed with sutures or surgical glue. In the next few months, tissue will form around the mesh to help hold it in place.

Two common surgery options include tension-free vaginal tape (TVT) and transobturator tape (TOT). The main difference between these two surgeries is the path that the needle is moved through to place the mesh. With TVT, the needle passes near the bladder, bowel and blood vessels. With TOT, the needle does not pass as close to these structures which may decrease the risk of complications.

Immediately After Procedure

After surgery, you will be monitored in a recovery room. You will most likely have a catheter in place to drain your urine.

How Long Will It Take?

30-90 minutes

How Much Will It Hurt?

Anesthesia will block pain during the surgery. After surgery, you may experience some pain or soreness. You will be given
pain medicine
to relieve discomfort.

Average Hospital Stay

You may be able to go home the same day. If complications arise, you may need to remain hospitalized.

Postoperative Care

At the Hospital

The medical team will monitor to make sure urine is passing as expected. Walking is generally encouraged to help promote recovery and decrease risk of certain complications.

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

Washing their hands

Wearing gloves or masks

Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

Washing your hands often and reminding visitors and healthcare providers to do the same

Reminding your healthcare providers to wear gloves or masks

Not allowing others to touch your incisions

At Home

There will be some activity limits after the procedure. Lifting and strenuous exercise will be limited for 6 weeks.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills

Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision sites

Pain that you cannot control with the medications you have been given

Cough, shortness of breath, or chest pain

Severe nausea or vomiting

Trouble urinating

Pain, burning, urgency, or frequency while urinating

If you think you are having an emergency, call for emergency medical services right away.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.